Is the NHS close to reaching the nirvana of true interoperability?

Is the NHS close to reaching the nirvana of true interoperability?

The ability of different agencies and systems in the NHS to connect with each other and enable swift, secure, shared access to data is critical to the provision of joined-up healthcare. The health service has a target, issued within the National Information Board’s ‘Personalised Health and Care 2020’ framework, to reach this interoperability by 2020 by when all patient and care records must be digital, real-time and interoperable.  Sharing is caring, and when it comes to patient information, this has never been more true.


Empowered patients and professionals

IT investment in the NHS to generate interoperability is frequently lambasted, the latest being the delay in the IT system supporting Scotland’s NHS 24, for example, with costs forecast to come in more than 70% over budget. There’s no doubt that interoperability comes at a high price, but without secure access to data shared across interconnected systems and technologies, we would miss out on the opportunities generated by the data-driven digital economy. We would receive fragmented care through disconnected systems, delivered by frustrated healthcare professionals. And we, as patients, would feel disempowered: think back to the days of indecipherable doctors’ handwriting on hastily-scribbled prescriptions.

Now, we prefer to take ownership of our healthcare: we have a right to view information stored on ourselves, and expect to exercise control in how it’s used. We have health and fitness wearables, access to online communities, cloud-based systems accessible from any device, healthcare apps, patient portals, SMS appointment reminders and online booking systems. Healthcare is transforming, integrating physical and digital landscapes, empowering professionals to deliver a seamless, interconnected patient experience. Interoperability will accelerate this change.


A Herculean task 

Achieving full NHS interoperability is a Herculean task. The NHS deals with a million patients every 36 hours1. With the average hospital having around 100 different IT systems2, and 57 million patients documented within GPs records alone (despite census data suggesting this should stand at only 54 million), it’s no surprise that achieving IT interoperability across the health service is a prized goal, long sought-after by patients and professionals alike. Preparing for GDPR compliance, coming into force as of May 2018, adds further pressure to  reaching the interoperability nirvana, demanding a stringent, robust approach to patient data and requiring a firm grasp of the understanding of patient consent.


A positive sentiment

Despite the complexities, certainly the mood within the NHS Trusts we work with is one of optimism. Many of them are making great progress towards the 2020 goal, and driving interoperability is already having a real impact on service delivery. Some, for example, are implementing digital scanning desks to remove the delays caused by cumbersome physical paper trails, helping to eliminate risk and achieve compliance with the digital scanning and circulation of sensitive patient information. Staff can access information from multiple locations in seconds, rather than sifting through stacks of physical records. These trusts are not just tearing out old systems and replacing them with new: they’re reconsidering their entire approach to the service they provide to patients; to professionals; and to their organisations. The technologies they select are facilitating this new, connected, holistic approach, improving processes and productivity, streamlining administrative tasks and transforming operations.

A report from Think Tank the Nuffield Trust3, ‘Delivering the benefits of digital health care’, echoes this positive sentiment. Where previously, it states, GP practices have been ahead of the game in their digitalisation of patient records, now community- and hospital-based services are catching up and NHS acute trusts ‘have the technology to support mobile working, e-rostering, patient-flow software and EHRs [electronic health records]’.


Are we there yet? 

The complexities and size of the task mean we still have a long way to go before we reach full interoperability. Certainly there are factors making a positive contribution to the goal, such as:

–        The adoption of a patient-centric approach

–        Commitment from vendors to achieving interoperability

–        A willingness of healthcare providers to overcome any barriers

–        The ability to create Local Digital Roadmaps

–        Shared stories of best practice

–        The  Interoperability Toolkit published by NHS England

–        The Code4Health Interoperability Community to create a common and open set of APIs to support information sharing

–        The digital maturity assessment tool

–        The collective desire to use the NHS number as a unique identifier through the patient journey

–        Action groups driving change: INTEROpen formed to help accelerate the development of open standards for interoperability, for example

Achieving full interoperability doesn’t depend on a ‘go live’ date, an application launch or a staff training session having been completed. It’s an intricate, complex and multi-faceted web of complexity, with the potential to bring about the most far-reaching change the UK’s healthcare landscape has experienced since the birth of the NHS.